To achieve simplified and integrated systems, states need to develop, adopt and implement consistent policies for new eligibility categories across state health subsidy programs.

*Milestone details:

*Full name: Adopt state policies necessary to implement new eligibility categories for Medicaid, the basic health program, if adopted, CHIP, and federal tax credits through the Exchange.

*Relevance to the ACA:

The ACA establishes new eligibility categories or determination methods for Medicaid and CHIP, and also creates a basic health program option and Exchange tax credits. Consistent with federal guidance and state policy making rules, States will need to develop policies to implement these new categories and methods. States also may need to review policies for categorical eligibility determinations to promote as much consistency with the new income based methodologies as possible. Provisions relevant to new eligibility categories include:

§1331 – Requirements for the establishment of a basic health program.

§1401 – Premium tax credits eligibility guidelines.

§1411 – Eligibility determination procedures for the Exchange and federal tax credits.

§2001 – Medicaid expansion to cover individuals with income below 133% of the federal poverty level.

§2002 – Eligibility determination for Medicaid using MAGI.

§2101 – Eligibility standards for children through September 30, 2019.